A massage gun may seem like a quick and effective way to smooth out a knot in your muscles—but neurologists warn people to be careful where on your body you use these contraptions. Massaging the neck, in particular, can pose severe risks to the body, including stroke. It can be important to educate your patients about these risks, and encourage them to seek medical attention for neck pain instead.

 

How do massage guns on the neck increase stroke risks?

 

José M. Morales, MD, MSc, a vascular neurologist and neurointerventional surgeon at Pacific Neuroscience Institute in Santa Monica, California, explains that using a massage gun on the neck can weaken tissues or lining around the arteries, increasing a person’s risks for a dissection in the arteries in their neck. This can include a cervical artery dissection (CeAD), which is one of the leading causes of ischemic stroke.

Cervical Artery Dissections: Etiopathogenesis and Management. Vascular Health and Risk Management. September 2, 2022.

Massage guns on the neck can both increase risks that this dissection forms or worsen an already-existing tear.

 

The exact connection between massage guns and CeAD has not been abundantly studied, but there has been some research linking the two. In 2022, a case report showed a 27-year-old female was discovered to have a vertebral artery dissection, a type of CeAD, after “repetitive use of a handheld massage gun.” Study authors did not mention whether the subject had undergone a stroke, but said she suffered symptoms like headache, neck pain, and dizziness.

Case Report: Vertebral Artery Dissection After Use of Handheld Massage Gun. Clinical Practice and Cases in Emergency Medicine. May 6, 2022.

Another case report from 2023 showed a 43-year-old woman who presented with symptoms of a severe headache and neck pain, and was later diagnosed with VAD. This woman said she had used a self-administered massage gun three weeks prior to her symptom onset.

Home Self-Massage Device Necessitates Public Awareness: Vertebral Artery Dissection Associated With a Home Massage Device. Cureus. January 5, 2023.

 

If describing these massage gun risks to patients, it may be helpful not only to inform them of the potential symptoms but also paint a picture of what CeAD looks like in the body—which can help explain why these tools are dangerous.

To do this, Dr. Morales compares the arrangement of the arteries to the layers of an onion. Meaning, they’re vulnerable. Like an onion, he explains that although the layers are resting on top of each other, “force or manipulation can dislodge [one] from the rest.”

“That's essentially what forms the dissection that leads to interruption of blood flow, the aggregation of platelets—which are the sticky elements of our blood that form clots—and then eventually stroke,” Dr. Morales says. “And so, the literature is pretty rife with examples of people having a stroke after a [neck] massage or chiropractic manipulation.”

 

Who is at risk for a dissection? 

 

Some people can be at higher risk for cervical artery dissections than others, making them more vulnerable to a stroke from a neck massage. Among these are people with a family history of tissue frailty and women.

Cervical Artery Dissections with and without stroke, risk factors and prognosis: a Chilean prospective cohort. Journal of Stroke and Cerebrovascular Diseases. June 14, 2020.

Risks can be higher for females due to their biological body composition,”as females also tend to not in general have as many muscles as men,” making their tissues more vulnerable, Dr. Morales says.

 

However, people in these groups do not necessarily have a dissection—and people outside of it don’t necessarily not have one, either.

“As a specialist in this field, my general mantra or thesis is to avoid any sort of neck manipulation or maneuvers—whether that means using a tool like a massage gun, having a chiropractor do some sort of manipulation, or having a masseuse do a deep muscle massage in your neck,” Dr. Morales says.

If a patient is dealing with neck pain, rather than direct them to a neck massage of any kind, he suggests helping them look into the underlying cause of their symptoms—or referring them to a specialist who may have a better idea. Sometimes neck pain can result from weakness elsewhere in the body, which can be helped through exercise or physical therapy, he says.

Ultimately, it’s a good idea to remind everyone to take care of their bodies, not assume that they’re “built out of steel” and prioritize treating the underlying problems that are causing neck pain over the immediate relief a massage can bring.